Adjustments of heart failure medication after implantation of a cardiac resynchronization therapy defibrillator.

AIM: "Optimal" medical therapy is mandatory before implantation of a cardiac resynchronization therapy (CRT) device, but "optimal" is not further specified. We determined the number of patients on a specific drug, the percentages of recommended target doses of the drugs the patients were on and their evolution over time. METHODS: Drug therapy (ACE-inhibitors (ACE-I), AT-receptor antagonists (ARBs), betablockers) of 140 patients with a follow-up of at least one year was studied. Response to CRT was defined as reduction in NYHA class ≥1. RESULTS: Age was 66±9 years, follow-up 43±25 months during which 28 patients (20%) had died. At baseline, 81 % of patients were on a betablocker compared to 95% after 3 years (P-value 0.02). Percentages of target doses were 55±34% and increased to 68±41% after 3 years (P-value <0.02). Percentages were increased in responders (58±40% to 72±32%, P-value 0.01 after 3 years), but not in non-responders (57±31% to 56±38%). At baseline, 97% of patients were on ACE-Is/ARBs and 100% after 3 years. Mean percentages of target doses were 78±43% at implant and between 73±40% and 79±49% during follow-up. Percentages were stable both in responders (83% at implant, 78% after 3 years) and in non-responders (80%/87%, both P-value n.s.). CONCLUSION: Even though quantity and quality of drug therapy at baseline was on an acceptable (betablockers) or high (ACE-Is/ARBs) level, physicians must be very observant on therapy during long-term follow-up, especially on target doses of betablockers in non-responders.

Physically abusive parents and the 16-PF: a preliminary psychological typology.

A typology of physically abusive parents was developed based upon personality characteristics measured by the 16-PF. Cluster analysis revealed five distinct patterns, accounting for 81 of 82 profiles submitted. Significant differences among the clusters were found on 14 of the 16 factors. The following types were described: (a) Shy, withdrawn, apprehensive, sober, and restrained; tending to have the least education, the greatest number of children. (b) Parents presenting as "normal" in personality features; tending to have relatively more education, fewer children. (c) Compulsive, bold, dominant, and assertive; tending to be highly manipulative in self-presentations, have high educational levels, and be older than other types. (d) Basically passive and submissive; tending to come from families where both parents are abusive. (e) Isolated, withdrawn, suspicious, tense, and apprehensive; tending to be more psychologically disturbed. Significance tests on external variables performed to validate the solution found differences among clusters in age, education, number of children, number of parents involved in abuse, 16-PF Faking Good and Faking Bad scores, and MMPI Scales L, F, K, 4, 5, 6, 7, and 0. Distinguishing personality features and demographic characteristics of the types are discussed with a focus upon possible treatment approaches for each type. Limitations of the study and suggestions for future research are addressed.